INTRODUCTION
METHODS
Search Strategy
Inclusion and Exclusion Criteria
Data Collection Process
Quality Assessment
RESULTS
Article Selection (Figure 1)
Demographics (Figure 2)
Intervention Type (Table 1, Figure 3)
Reference | Design | Outcome Type | Intervention Type | Intervention(s) | Setting | Sample Size Race/Ethnicity | Follow up | Results | DB Score |
---|---|---|---|---|---|---|---|---|---|
Miller et. al. 200521
| RT | Screening-Completion of FOBT | PL-E | A multimedia computer program vs. nurse counseling on FOBT use and collection (usual care). | Outpt |
N = 204 | 30 d | No difference in FOBT completion intervention 62 % (58/93) vs. usual care group 63 % (64/101); p = 0.89. Knowledge mastery (>5 correct responses) was similar between groups (p = 0.09). | 26 |
Black: 72 % | |||||||||
FOBT Knowledge assessed by 6 item post-intervention questionnaire | White: 28 % | ||||||||
Stokamer et. al. 200532
| RT | Screening-Completion of FOBT | PL-E | One-on-one education sessions plus FOBT and brochure vs. standard education group with FOBT and brochure. | VA Outpt |
N = 788 | 6mo | FOBT completion higher in the intervention group 65.9 %, vs. standard education 51.3 % (p < 0.001). No difference in FOBT completion by race/ethnicity (p = 0.655) | 25 |
Black: 35 % | |||||||||
Hisp/Lat:15.9 % | |||||||||
White: 45.6 % | |||||||||
Basch et. al. 200630
| RT | Screening-Completion of FOBT, Sigmoidoscopy, Colonoscopy, or Barium Enema | PL-E | Tailored telephone education based on behavioral and educational theory vs. mailed brochure. | Comm |
N = 456 | 6 mo | Screening documented in 27.0 % of intervention group vs. 6.1 % in control; OR 4.4 (95 % CI 2.6, 7.7). | 24 |
Black: 63.2 % | |||||||||
White: 16.2 % | |||||||||
Other: 19.7 % | |||||||||
Walsh et. al. 201029
| RT | Self-reported up-to-date screening with FOBT Or Any CRC Screening (FOBT, Sigmoidoscopy, and/or Colonoscopy) | PL-E | (1) Bilingual culturally tailored brochure with FOBT or (2) Bilingual culturally tailored brochure with FOBT plus telephone counseling by a community health advisor vs. (3) usual care. | Outpt |
N = 1789 | 1 yr | Participants in brochure/counseling group were more likely to report FOBT screening vs. usual care. OR = 1.89 (95 % CI 1.34, 2.66), compared to OR = 1.18 (95 % CI 0.84, 1.66) in brochure alone group; In the Vietnamese population, the addition of counseling further increased FOBT rates OR 3.02 (95 % CI 1.77, 5.14) compared to brochure only OR 1.33 (95 % CI 0.80, 2.20). | 24 |
Hisp/Lat: 52.9 % | |||||||||
Asian: 47.1 % | |||||||||
Goldberg et. al. 200425
| RT | Screening-Completion of FOBT | PL-O | Mailed FOBT with appointment reminder letter 2 weeks prior to scheduled clinic appointment vs. usual care. | Outpt |
N = 119 | 1 yr | Index appointment FOBT completion was 35.6 % intervention group vs. 3.3 % usual care group, OR = 16.0 (95 % CI 3.5, 71.4). One year, FOBT completion intervention vs. usual care OR = 13.0 (95 % CI 3.6, 45.5). | 23 |
Black: 82 % | |||||||||
Hisp/Lat: 3 % | |||||||||
Makoul et. al. 200922
| PP | Viewer rating and intention to discuss screening assessed by posttest structured interview. Willingness to consider FOBT, sigmoidoscopy, or colonoscopy; and screening knowledge assessed pretest and posttest by structured interview | PL-E | Culturally tailored CRC screening educational video with positive introductory appeal vs. negative introductory appeal. | Outpt |
N = 270 | NA | No difference in positive vs. negative introduction for viewer rating, knowledge, willingness, or intention (p value not reported). | 22 |
Composite willingness to consider FOBT, sigmoidoscopy, and colonoscopy increased pretest vs. posttest (p < 0.001 for each). Composite mean knowledge scores increased from 3.8 pretest to 6.3 posttest (p < 0.001). | |||||||||
Hisp/Lat: 100 % | |||||||||
Potter et. al. 200926
| RT | Screening-Completion of FOBT; or up-to-date screening with Sigmoidoscopy, Barium Enema, or Colonoscopy | PL-O | FOBT distribution and education at time of annual flu shot clinic visit with reminder phone calls at 3 and 6 weeks vs. flu shot alone with usual care. | Outpt |
N = 514 | 6 mo | Intervention group FOBT completion increased from 54.5 % at baseline to 84.3 % at follow-up (p < 0.001) vs. 52.9 % to 57.3 % (p = 0.071) in the usual care group. 68.0 % of intervention group became up-to-date with screening vs. 20.7 % for usual care group (p < 0.001), OR = 11.3 (95 % CI 5.8, 22.0) | 22 |
Asian: 56.1 % | |||||||||
Hisp/Lat: 25.2 % | |||||||||
Black: 6.1 % | |||||||||
Myers et. al. 200731
| RT | Screening-Completion of FOBT; or self-reported/documented Sigmoidoscopy, Colonoscopy, or Barium Enema | PL-E | Participants assigned to 1 of 4 interventions: Usual care; Standard Intervention (SI) with letter, information booklet, and FOBT; Tailored Intervention (TI), or Tailored Intervention plus reminder phone call (TIP). | Outpt |
N = 1546 | 24 mo | CRC screening use intent-to-treat analyses: control group 33 %; SI group 46 % (OR = 1.68, 95 % CI 1.25, 2.53); TI group 44 % (OR = 1.58, 95 % CI 1.18, 2.12) TIP group 48 % (OR = 1.91, 95 % CI 1.42, 2.56). Screening did not differ across intervention groups (p > 0.1 for all). | 21 |
Black: 58 % | |||||||||
White: 38 % | |||||||||
Jacobs et. al. 200128
| Cohort | Screening-Completion of annual FOBT | PL-O | Professional interpreter services provided at 4 of 14 clinics serving limited-English-speaking patients vs. comparison group of randomly selected adults representing 10 % of the eligible population. | Outpt |
N = 327 | NA | FOBT completion intervention vs. comparison group OR = 0.66 (95 % CI 0.44, 0.99; p < 0.5) year one; OR = 0.86 (95 % CI 0.57, 1.28) year two. No change in FOBT completion year one vs. year two in intervention (p = 0.28) or comparison group (p = 0.35). | 20 |
Spanish speaking: 79 % | |||||||||
Portuguese speaking: 21 % | |||||||||
Tu et. al. 200627
| RT | Screening-Completion of FOBT | PL-E | Trilingual health educator plus culturally tailored video and print materials vs. usual care. | Outpt |
N = 210 | 6 mo | FOBT completion greater in intervention group 69.5 % vs. usual care 27.6 %; Age adjusted OR = 5.91 (95 % CI = 3.25, 10.75) | 20 |
Asian: 100 % | |||||||||
Fitzgibbon et. al. 200719
| RT | Screening-Completion of FOBT, Flexible Sigmoidoscopy, or Colonoscopy Provider recommendation assessed by chart abstraction | PL-E; PSL | Physician education/feedback sessions plus patient education with tailored video, pamphlet, and FOBT distribution with simplified instructions vs. usual care. | VA Outpt |
N = 986 | 6-18 mo | Providers who attended intervention sessions recommended CRC screening more (64 % vs. 54 %, p = 0.004) and their patients completed CRC screening more (42.3 % vs. 29.5 %, p = 0.02) vs. providers that attended no sessions. Patients in the intervention group were more likely to have screening recommended (83.7 % vs. 74.6 %, p = 0.003) vs. usual care. No difference in screening completion (39.5 % vs. 41.6 %, p = 0.61). | 19 |
Black: 50 % | |||||||||
White: 45 % | |||||||||
Friedman et. al. 200124
| RT | Screening-Completion of FOBT | PL-E | Culturally tailored video featuring peer educators and health professionals vs. standard print education. | Outpt |
N = 160 | 3 mo | FOBT completion did not differ between the video 43.6 % vs. standard education 36 % (p = 0.847). Knowledge, self efficacy, and intent scores were higher in the video vs. standard education (F-stastistics, p < 0.001 for each). | 19 |
Black: 87.5 % | |||||||||
CRC knowledge assessed by 16-item measure | |||||||||
Hisp/Lat: 5 % | |||||||||
Self efficacy and intent assessed by single item measure | |||||||||
Hoffman et. al. 199123
| Cohort | Stage of CRC at time of diagnosis | PL-E, PSL | Educational pamphlet; distribution of free FOBT kits; nurse FOBT demonstration; and multidisciplinary protocol for diagnostic evaluation and treatment of FOBT positive patients vs. usual care | Outpt |
N = 8192 | 65 mo | There were 0 % modified Dukes’ stage D and 35 % (6/16) stage A in the intervention group compared to 33 % (114/346) Dukes’ stage D and 0 % stage A for usual care. Intervention cohort were diagnosed at an earlier Duke’s stage vs. usual care (p = 0.003). | 10 |
Black: 95 % | |||||||||
Dietrich et al 200634
| RT | Screening adherence according to USPSTF guidelines | PL-N | Frequent (mean 4) phone call follow up from a prevention care manager versus usual care. | Outpt |
N = 1,413 | 18mo | 24 % in intervention group vs. 11 % in control group were screened; a 13 % difference (95 % CI: 0.07-0.19), p < 0.001. | 27 |
Race/Ethnicity not provided; however, 64 % of patients listed Spanish as primary language | |||||||||
Percac-Lima et al. 200836
| RT | Screening with colonoscopy, sigmoidoscopy, barium enema, or FOBT during study period | PL-N | Culturally tailored patient navigator program | Outpt Comm |
N = 1,223 | 9 mo | 27.4 % of intervention vs. 11.9 % of control group were screened within the follow-up interval (p < 0.001). | 24 |
Hisp/Lat: 40.1 % | |||||||||
Black: 6.4 % | |||||||||
Asian: 1.5 % | |||||||||
Jandorf et. al. 200538
| RT | Screening with FOBT, flexible sigmoidoscopy, or colonoscopy | PL-N | Patient navigator (PN) intervention (including written reminders, telephone calls, and scheduling assistance) | Outpt |
N = 78 | 6 mo | 23.7 % of PN group vs. 5.0 % of control group received screening endoscopy in the follow-up interval (p = 0.019). | 23 |
Hisp/Lat: 82.1 % | |||||||||
Ford et. al. 200635
| RT | Screening with sigmoidoscopy at 3 years after baseline screening | PL-N | Case management intervention with outreach (at least monthly), service planning, service linkage, monitoring, and advocacy vs. usual care. | Outpt |
N = 703 | 3 yr | Flexible sigmoidoscopy was completed by 68.9 % of low-income patients in the intervention group and 51.3 % in the control group (p = 0.10). In the moderate-to-high income group, 53.8 % of patients in the intervention arm vs. 62.5 % of patients in the control arm completed flexible sigmoidoscopy (p = 0.22). | 22 |
Black men: 100 % enrolled in the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial | |||||||||
Nash et. al. 200639
| PP | Screening-Receipt of colonoscopy per month in pre versus post intervention period. Provider/System-Broken appointment rate pre and post intervention | PL-N | Direct Endoscopic Referral System and patient navigator system at an urban public hospital. . | Outpt |
N = 1,060 | 11 mo | The average number of Medicaid patients undergoing screening colonoscopy per month increased from 17.0 pre to 48.4 post-intervention (p < 0.001). Broken appointment rates for colonoscopy decreased from 67 % pre to 5 % post-intervention. The authors noted a RR of 2.6 (95 % CI 2.2-3.0) of keeping a colonoscopy appointment in the post-intervention compared to the pre-intervention setting. | 20 |
PSL | Hisp/Lat: 69 %-79 % | ||||||||
Black: 6 %-17 % | |||||||||
Chen et. al. 200833
| Cohort | Screening-Completion of colonoscopy over 30 month review period. | PL-N | open-access endoscopy scheduling and patient navigator services (providing education, reminder phone calls, transportation assistance, and face to face meetings) | Outpt |
N = 532 | NA | 353 (66 %) of navigated patients completed colonoscopy (Compared to 43 % in East Harlem Area). | 16 |
PSL | Hisp/Lat: 55 % | ||||||||
Black: 30 % at East Harlem Hospital | |||||||||
Provider/System-No Show Rate | |||||||||
Hispanics more likely to complete than AA (OR 1.67;95 %CI 1.1-2.5) | |||||||||
No show rate dropped from 40 % to 9.8 %. | |||||||||
Christie et. al. 200837
| RT | Screening-Completion of Colonoscopy | PL-N | patient navigator intervention vs. usual care. screening colonoscopy rates during follow-up interval. | Outpt |
N = 21 patients | 3 mo | 53.8 % of the navigated patients completed colonoscopy versus 13 % of non-navigated patients (p = 0.085). 63 % of patients in the non-navigated group refused colonoscopy compared to 23 % in the navigated group. | 16 |
Hisp/Lat: 71 % | |||||||||
White: 22 % | |||||||||
Dietrich et al 199847
| RT | Screening-Completion of FOBT or sigmoidoscopy | PSL | Multi-modal intervention (workshops, reminders, clinic flow sheets) designed to increase recommendations and scheduling of CRC screening tests. | Outpt |
N = 2648 | 24 mo | There were no statistically significant differences (p > 0.05) between the intervention and control clinics in terms of FOBT or sigmoidoscopy use from baseline to 24 month follow up. | 25 |
Black: 30 % | |||||||||
Hisp/Lat: 22 % | |||||||||
White: 22 % | |||||||||
Unknown: 20 % | |||||||||
Ferreira et al. 200548
| RT | Screening-Completion of FOBT, sigmoidoscopy, or colonoscopy | PSL | Multi-modal intervention including educational sessions on communicating with patients with low literacy skills as well as feedback sessions at which individual and group level colon cancer screening data were presented. | Outpt |
N = 1,978 | 18 mo | Physicians in the intervention group were more likely to recommend screening, as measured by chart audit within 6-18 months of the first visit (76 % vs. 69.4 %, p = 0.02), and their patients were more likely to complete screening (41.3 % vs. 32.4 %, p = 0.003). Results were most impressive for a pre-planned subset of analysis of patients with low literacy skills (55.7 % vs. 39.0 %, p = 0.002). | 23 |
Black: 50 % | |||||||||
Process-Physician recommendation of CRC screening | |||||||||
Pre-planned subset analysis among low health literacy patients | |||||||||
Khankari et. al. 200746
| PP | Screening-Completion of FOBT, sigmoidoscopy, or colonoscopy | PSL | Manual tracking of patients; physician and patient education; and establishment of a monitoring “feedback loop”. The outcomes of interest were rates of physician CRC screening recommendation (measured by provider chart audit at 12 months post-intervention) and patient completion of CRC screening. | Outpt |
N = 174 | 12 mo | Physician recommendation of CRC screening increased from 31.6 pre- to 92.9 % (p < 0.001) post-intervention. Completion of CRC screening at 12 months increased from 11.5 % pre- to 27.9 % (p < 0.001) post-intervention. | 21 |
PL-O | Black: 51.7 % | ||||||||
Hisp/Lat: 44.8 % | |||||||||
Process-Physician recommendation of CRC screening | |||||||||
Sheinfeld-Gorin et. al. 200045
| PP | Knowledge-survey questionnaires of CRC barriers, prevention and screening knowledge | PSL | Primary care physicians received individualized information on current cancer prevention and screening recommendations vs. a control group with no intervention. | Outpt |
N = 122 | 18 mo | No significant difference between groups in self-reported cancer prevention and screening practices (survey score 9.82 vs. 9.63, p = 0.42). Intervention group physicians identified significantly fewer barriers to practice post-intervention compared to control physicians (survey scores 4.73 vs. 5.35, p < 0.05). | 20 |
Black: 32 % | |||||||||
Hisp/Lat: 24 % | |||||||||
Lane et al. 200844
| RT | Screening-Completion of FOBT, sigmoidoscopy, or colonoscopy | PSL | CME approved didactic sessions. | Outpt |
N = 2,224 | 12 mo | 16 % increase in CRC screening amongst patients seen by physicians in the intervention group (post-intervention) compared to a 4 % increase in CRC screening in the control group (measured by chart audit in the 1 year period before and after intervention), OR 2.25 (95 % CI: 1.67, 3.04). | 19 |
“Non-White”:78 % | |||||||||
Process-Physician recommendation of or referral for CRC screening | |||||||||
Roetzheim et al. 200449
| RT | Screening-completion of FOBT | PSL | Multi-modal intervention consisting of checklists, chart reminders, and feedback of screening rates to clinic staff. Rates of completion of FOBT at baseline and follow-up were assessed in 150 charts randomly selected from each clinic. | Outpt |
N = 1,196 | 12 mo | There was a 14 % absolute improvement in FOBT completion (OR 2.56, 95 % CI [1.65-4.01], p < 0.001) for the intervention clinics versus control clinics, as measured by chart audit at 1, 2, and 3 months post-intervention. | 19 |
Black: 29 % | |||||||||
White: 48 % | |||||||||
Hisp/Lat: 23 % | |||||||||
Struewing et. al. 199143
| PP | Screening-completion of rectal exam, FOBT, or sigmoidoscopy | PSL | A multi-level intervention that included: systematic distribution of FOBT kits, housestaff and nursing education, and physician screening reminder cards. | Outpt |
N = 365 | 6 wks | No change in rectal exam or sigmoidoscopy was seen in any group at six weeks post-intervention. The proportion of patients compliant with three-day FOBT increased from 1.3 % pre to 56.8 % post-intervention (p < 0.001) | 19 |
Black: 51.2 % | |||||||||
White: 48.8 % | |||||||||
McPhee et al. 198950
| RT | Screening-completion of rectal exam, FOBT, or sigmoidoscopy | PSL | Provider reminders, chart audit with feedback, or no intervention. | Outpt |
N = 3,905 | 9 mo | Compared to controls, a cancer screening reminder system aimed at internal medicine residents increased FOBT rates by 19 % (P = 0.002), increased rectal exam rates by 23 % (p < 0.001), and increased sigmoidoscopy rates by 31 % (p = 0.002). | 17 |
Black: 25 % | |||||||||
Hisp/Lat: 17 % | |||||||||
Asian: 14 % | |||||||||
Armour et al. 200440
| Cohort | Screening-completion of FOBT, sigmoidoscopy, colonoscopy, or double-contrast barium enema | PSL | Financial bonuses as incentives to improve CRC screening rates. | Outpt HP |
N = 6,749 | NA | CRC screening use increased from 23 % to 26 % of eligible patients (p < 0.01) in the year after financial incentives were added. | 16 |
Black: 28 % | |||||||||
Parikh et al. 200141
| Cohort | Other-comparison of endoscopy results following 3-day at home FOBT vs. 1-day in-office FOBT | PSL | One-time, in-office FOBT was compared to 3-day home FOBT as a screening mechanism for CRC. | Outpt |
N = 350 | NA | There was good correlation between in-office FOBT and the 3-day FOBT test results (k = 0.6316). | 15 |
PL-O | Black: 52 % | ||||||||
Hisp/Lat: 19 % | |||||||||
Friedman et. al. 200720
| PP | Screening-completion of FOBT, rectal exam, sigmoidoscopy, or colonoscopy | PSL | Educational intervention with pre and post-intervention monitoring of cancer screening documentation in the medical record. | Outpt |
N = 166 | 6 mo | The proportion of orders for endoscopic CRC screening increased from 26.7 % pre to 59.1 % post-intervention (p < 0.0001). Performance of FOBT did not significantly change following the intervention. | 14 |
Black: 100 % | |||||||||
Zubarik et al.200042
| PP | Screening-completion of flexible sigmoidoscopy | PSL | Provider-directed educational materials stressing the importance of CRC screening and the availability of flexible sigmoidoscopy. | Outpt |
N = 121 | 5 mo | use of flexible sigmoidoscopy increased by 42 % (from x pre to y post-intervention, p = xxx). | 12 |
Inpt Comm | Black: 97 % | ||||||||
Lloyd et. al. 200751
| PP | Screening-completion of colonoscopy | PSL | Training primary care physician to perform screening colonoscopy. | Outpt Comm |
N = 50 | NA | The proportion of primary care patients screened by colonoscopy increased from 20 % pre- to 80 % post-intervention (p-value not provided). | 5 |
No patient race/ethnicity data reported. |